Pre School-5th Grade, Wednesday Education Registration 26-27

3-year-old (as of 9/1/2026) - 5th Grade

(If you have more than 2 children in this age group you will have to fill out this form again.)

PLEASE NOTE THAT THERE IS ONLY ONE SESSION THIS YEAR FROM 5:40-6:25 PM. *

PLEASE NOTE THAT THERE IS ONLY ONE SESSION THIS YEAR FROM 5:40-6:25 PM. 5:40-6:25PM
Child #1 Name Child #1 Name * First Last
Child #1 Gender *

Child #1 Gender Male Female
Child #1 Birthdate Child #1 Birthdate * / MM / DD YYYY
Child #1 Grade (applicable for Fall 2026) *

Child #1 Grade (applicable for Fall 2026) Pre-School 3rd Kindergarten 4th 1st 5th 2nd
Child #1 School (if applicable for Fall 2026) *
Child #2 Name Child #2 Name First Last
Child #2 Gender

Child #2 Gender Male Female
Child #2 Birthdate Child #2 Birthdate / MM / DD YYYY
Child #2 Grade (applicable for Fall 2026)

Child #2 Grade (applicable for Fall 2026) Pre-School 3rd Kindergarten 4th 1st 5th 2nd
Child #2 School (if applicable for Fall 2026)
Parent (Caregiver) Name #1 Parent (Caregiver) Name #1 * First Last
Parent (Caregiver) Cell Phone #1 Parent (Caregiver) Cell Phone #1 * - ### - ### ####
Parent (Caregiver) Email #1 *
Address Address *
Street Address Address Line 2 City State / Province / Region Postal / Zip Code Country
Parent (Caregiver) Name #2 Parent (Caregiver) Name #2 First Last
Parent (Caregiver) Cell Phone #2 Parent (Caregiver) Cell Phone #2 - ### - ### ####
Parent (Caregiver) Email #2
Parents will be assigned to teach during the school year. (1 MONTH PER CHILD) Please check the month(s) that work best for you- please do not double-book yourself if you have a 6th grade confirmation student during the same time.: *

Parents will be assigned to teach during the school year. (1 MONTH PER CHILD) Please check the month(s) that work best for you- please do not double-book yourself if you have a 6th grade confirmation student during the same time.: September October November December January February March
Can you/do you want to teach your child's class for more than one month? If so, select the months below that you wish to teach.

Can you/do you want to teach your child's class for more than one month? If so, select the months below that you wish to teach. September October November December January February March
Do your children have any special needs or restrictions?
Are you a member of Calvary Lutheran?

Are you a member of Calvary Lutheran? Yes No Would like to...
My child has permission to participate in any activity, games, hiking, and field trips planned for the Calvary Lutheran Education Program. I agree that the church, its personnel and volunteers and teachers will not be held responsible and hereby release them from any accidents which may occur.
THIS IS A RELEASE. I HAVE READ AND UNDERSTAND THIS RELEASE. *

Draw or Type

I understand this is a legal representation of my signature. Clear

Full Name

I understand this is a legal representation of my signature.
Date Date * / MM / DD YYYY
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In the number 73628, what is the 4th digit?